Florida is already facing a physician shortage. Nearly one in 10 Florida physicians reportedly plans to retire within the next five years, threatening to widen gaps in access to care across the state.
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That should make protecting Florida’s pediatric physician workforce a priority.
Florida is home to approximately 4.5 million children, including more than two million who rely on Medicaid. Yet Florida ranks just 35th in the nation for overall child well-being.
Against that backdrop, a recent change to Florida’s Medicaid payment system should concern every parent, physician and public official in the state.
Beginning in February 2025, Florida’s Agency for Health Care Administration (AHCA) moved behavior analysis services into the state’s Medicaid managed care system. These services provide important support for children with autism and other developmental conditions.
The problem is not that Florida funds applied behavior analysis. It should. The problem is how AHCA calculated the rates used to pay for those services.
Critics allege that AHCA’s methodology distributed anticipated behavior-analysis costs across geographic regions and age groups that use the services at very different rates. That included allocating funding to cover these services among newborns and adults, even though they are used almost exclusively by children and adolescents.
According to the filing, that methodology overfunded some populations while reducing the money available for core pediatric care in areas with greater pediatric needs.
Some estimate that reimbursement for core pediatric care has fallen by approximately 15%, amounting to about $15 million per month since February 2025.
AHCA has not publicly conceded that its rate-setting methodology was flawed. However, the agency reportedly acknowledged in an April letter to Medicaid managed care plans that including behavior-analysis services in certain value-based contracts had “the potential to result in access issues.” It encouraged plans and providers to renegotiate their agreements to reduce unanticipated financial losses.
That is not enough.
Pediatricians already typically earn less than physicians in many other specialties. When Medicaid reimbursement falls below the cost of providing care, practices face impossible choices: limit the number of Medicaid patients they accept, reduce services or leave the program altogether.
Families ultimately pay the price.
Lower reimbursement can mean fewer available physicians, longer waits for appointments, and greater reliance on emergency rooms for routine care. It can also mean delayed checkups, vaccinations, and screenings that help physicians identify health and developmental concerns early.
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Any parent who remembers the frequent visits of a baby’s first year understands why reliable access to pediatric care matters. Children cannot simply wait for the healthcare system to become financially sustainable again.
Gov. Ron DeSantis has said that he wants to invest in Florida’s children and build a healthier state. His proposed 2026–2027 budget included $10 million for pediatric cancer research. That commitment should extend to the primary care infrastructure children depend on every day.
The governor should direct AHCA to review the disputed methodology, correct any actuarial errors and ensure that future rates reflect where services are actually delivered.
This should not become a contest between pediatric primary care and services for children with autism. Florida must adequately fund both.
Children deserve access to pediatricians. Children with autism and other developmental conditions deserve access to appropriate behavioral services. A growing state with a strong economy should not force families and providers to choose between them.
Pediatric Associates, Florida’s largest pediatric primary care provider, has initiated a formal legal challenge seeking review of AHCA’s rate decisions. But providers and families should not have to wait for the administrative process to run its course if the underlying problem can be fixed now.
Florida’s leaders should act before more pediatricians are forced to reconsider whether they can afford to serve children covered by Medicaid.
Correct the formula. Restore appropriate pediatric funding. Protect children’s access to care.
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Nicolette Natale is a physician based in Fort Lauderdale.